Monday, January 2, 2012

Of Sleep

I recently came across this post: Ten Photos Proving the Taiwanese Can Sleep Anywhere, Anytime

I'm not surprised.

I'll even say that there's more than a grain of truth to this: I too have noted a higher percentage of people sleeping in all sorts of places at all sorts of times in Taiwan.

It starts in childhood, when as kids they go to school all day, then to cram school, and they're lucky if they get home at 11pm. I used to get on the MRT at Taipei Main at about 10pm twice a week - the person driving me would race to get there before the cram schools let out at  9:45 and the MRT was crammed to the gills with students. Then they've got homework. No free time, of course, not during the week. My estimate is that the average Taiwanese student gets about 3 hours of sleep a night.

OK, seriously, maybe not 3, but not more than 6.

There are exceptions to this rule - I tutor two girls on the weekend (it's not really a "class" - it's English Fun Time and I do it more because I've become attached to the girls and invested in their future than for the money) and they don't attend cram school every night, although they are pushed to do well academically within the bounds of reason.

Then there are the casualties: the nephew of one of my former clients (she's left that company), who had to be out the door at 7am for school, then cram school, home at 11:30pm because he lived out in Taipei County (I believe his parents own a small apartment in Taipei City, allowing him to attend high school here, but don't actually live there - it's actually quite common among the well-off in Taipei). Then homework, which he barely kept up with, if at all, then finally bed. He did all the extra homework on the weekend, as well as taking additional classes. By the time my student told me her concerns about him, what she described in his personality fit the signs of depression quite accurately - although I'm not a psychiatrist, I'll at least say that he should have been screened. It's sad that knowledge and treatment of mental health in Taiwan is so lacking that that'll probably never happen. I can't say, of course, if that was caused by his *ahem* rigorous academic schedule, but I sure can take an educated guess.

Then you get four years of relative freedom in college before you're bounced into the working world (or for men, military service, which might actually be another few years of decent sleep) and are working until long after a healthy person should go home to enjoy their family - usually around  7 or  8, but also fairly often until  9 or 10, and not uncommonly are the newest employees stuck with work on the weekend - unofficial work, of course, so they don't get overtime or comp time for it. They're just given more regular work than they can possibly do in 8 or even 10 hours.

It doesn't get much better as you climb the ladder - my students regularly report getting home at 9pm, 10pm or later - and I tend to teach the higher-ups.

When I ask, the most common answer I hear for how much sleep people actually get in Taiwan is about 6 hours, often less. I don't know about you, but while I can live on 6 hours, after a week or so of that I'm drained. It's all I can do to stay awake no matter where I am. I start to doze off whenever I sit down. I tested the limits of this in the USA, when my natural bedtime (around midnight) clashed with when I needed to be up for work (around 6am, maybe 6:10). I couldn't afford the thing that would have allowed me to wake up later - that being a car - and couldn't force myself to sleep before 11:30pm, maybe 11. I sure could doze off on my lunch hour or on the bus, though!

So is it really any wonder that you see people sleeping in all sorts of contortions in Taiwan?

Maybe if they didn't feel the push to study and work themselves* to exhaustion it wouldn't happen.

*by "themselves" I don't mean everyone, it's one of those general statements that's meant to describe observations of trends, not individuals


Catherine Shu said...

"It's sad that knowledge and treatment of mental health in Taiwan is so lacking that that'll probably never happen."

I can say from personal experience that that is not true. There is plenty of knowledge about mental health in Taiwan and excellent treatment available. The psychiatry departments in NTU and other major hospitals are just as busy and well-staffed as other departments (though I don't suggest going to a big hospital for any sort of routine medical care, unless you like sitting in a waiting room for two hours to see a doctor for 10 minutes). In terms of medical resources, Taiwan is not a mental health backwater. Most of the professionals I've dealt with or spoken to here have been just as competent and knowledgeable as their counterparts in the US.

Are you talking about stigma, though? Because that IS a problem. But there is a huge difference between people lacking access to "knowledge and treatment" because it doesn't exist, and people being prevented from seeking those resources because of shame.

Jenna Lynn Cody said...

Knowledge of mental health by mental health professionals, yes - although while it wasn't my personal experience I can speak through the experience of trying to help a friend dealing with depression.

When I said "knowledge" I guess I meant what you are defining as "stigma" - knowledge among regular people, not doctors, about the signs, symptoms and treatment of mental health is severely lacking. The doctors generally know what they are doing (although my own 'experience' says that that's not always true), but if your frame of reference is as a Taiwanese person with a Taiwanese cultural reference and support system... well, what I found is that it's just not the same.

In the US if you're showing signs of depression that would make a screening a good idea, someone will generally at least suggest a screening. Someone will at least pick up on the idea that it's a problem requiring professional help. What I experienced through my friend's struggle is that here, that knowledge doesn't, well, I don't want to say "doesn't exist at all" but generally speaking, that is what I mean. So nobody suggested to the kid in my post to get screened, to see someone, to seek out any kind of therapy. Either it was so stigmatized that nobody dared say anything or it just wasn't seen as a "potential mental health problem".

What my friend experienced is also tough to talk about - she tried to find talk therapy and couldn't. Now that I've been here awhile I know I could have pointed her to the Community Services Center, but at the time I had been here less than a year and didn't know that resource existed. She honestly couldn't find much in the way of talk therapy that wasn't through a church - and she wasn't interested in hearing about how "trust in God" would cure her - it made her feel worse, in fact.

She saw psychiatrists, although what I really think she would have benefited from (not that I would necessarily know, but it's a conclusion I have faith in) was talk therapy. One said she was just "going through a phase" and told her to come back later (!!) if she still felt bad. Another put her on Wellbutrin without much of a screening at all (I know, I was in the waiting room, the time he took with her was far too short) which made her symptoms worse, not better, and it did not improve with time. He was quite unwilling to give her anything else, claiming that it should work and ignoring her pleas to the contrary.

Soon after that we moved out, and she cut off contact. I don't know what happened, and I hope she got the help she needed, but it did NOT fill me with faith in mental health care in Taiwan, despite having a few very good psychiatrists as students (although one works in head trauma rehabilitation, which is a different field altogether).

Jenna Lynn Cody said...

I should add that although this friend was born in the US, her entire family save her mother lived in Taiwan and had not lived abroad, and her friends and sort-of-it's complicated-boyfriend, such as she had them (it didn't seem like she had many friends here) were Taiwanese.

Pretty much the only reasons why she saw a doctor at all were that a.) growing up in the USA she was exposed to a culture where that is something people are more likely to do if they feel depressed and b.) I was her roommate and recommended a screening when she told me how she was feeling (and then went with her to see various professionals.

Her Taiwanese family and friends did not think it was a problem, and her sort-of boyfriend was supportive but not actively helpful.

Catherine Shu said...

I've been through everything your friend has... unfortunately, I'm pretty well-acquainted with the shortcomings in how mental illness is dealt with in both American and Taiwanese culture. There are many blessings to growing up bicultural, but that sure wasn't one of them. I want to write about it more on my blog, but to sum it up based on my personal experiences... in Taiwanese culture, stigma means that people err on the side of inaction, while in the US doctors sometimes err on the side of doing too much with the bare minimum of attention paid to the potential side effect of medications. And in both countries, you are personally blamed for your symptoms by ignorant people and often treated like an idiot.

I really don't want to sound like I'm nitpicking you, but does your friend know that you are writing about her experience on your blog? Obviously, I don't know what your relationship is with her or if she even reads here, but it can be a extremely upsetting to stumble upon your struggle with a mental disorder being discussed without your knowledge in public.

Of course, if she's open to that, it can be a positive thing. The more people talk about their experiences with clinical depression and other mental health issues, the less of a problem stigma will be... but I really think it's up to each person. It literally took me a decade to be comfortable discussing my own experiences in public -- or even with my friends -- so I'm pretty sensitive to that.

Jenna Lynn Cody said...

No worries, I thought about that too when I started to write the comment.

She's not really my friend anymore although we didn't have a falling out - and we were "close" for a period more as a matter of circumstance (roommates) than actual chemistry/shared interests.

I won't go into the whole story here, but basically Brendan and I felt compelled to move out on somewhat short notice, and we didn't stay in touch.

I have no reason to believe she reads this blog - although she grew up in the USA, living in Taiwan her main cultural reference is Taiwanese rather than expat. She's not really in the demographic of people who usually read this blog. Last I heard she was planning to go back to the USA, so my guess would be "no".

If she did by chance find it, well, that's why I'm trying to steer clear of identifying items such as family details, her name, the events surrounding our moving out, and trying to stick to the details that make the story a pertinent one for discussion of mental health care in Taiwan through a cultural lens. She might know it's her, but nobody else would.

Catherine Shu said...

"I have no reason to believe she reads this blog - although she grew up in the USA, living in Taiwan her main cultural reference is Taiwanese rather than expat."

It sounds from what you've described that your friend's background is similar to mine. Though I've lived in Taiwan for 4.5 years now, I would say that my main cultural reference is the USA... because I was born there, my experiences were shaped there and no matter how long I live in Taiwan, I will always consider myself American and an expat. I'm curious about how her main cultural reference would be Taiwanese, if she grew up in the US. I think she sounds like part of the audience for your blog -- after all, I am, aren't I? -- but of course she was your friend and you would know better than me.

Jenna Lynn Cody said...

It's just what I observed during our (admittedly brief) roommateship. Her friends such as she had them were all Taiwanese, so was her boyfriend, and every other relative other than her mother. She'd also clearly spent significant time in Taiwan growing up and spoke Chinese and Taiwanese with what I know know is a strong Kaohsiung accent.

I don't know about her life in the USA (we weren't *that* close) but in Taiwan I seemed to be her only expat friend or connection.

Jenna Lynn Cody said...

Plus, I can't put my finger on why, but if I had to pinpoint what she "broadcast" as her main cultural reference, it would be Taiwanese. There was a lot that was American about her but fundamentally she seemed very local. Far more than pretty much any other person of Taiwanese heritage born in the USA I've met.